The role of family physicians in the management of cancer patients.

Eight functions of health care--identifying and monitoring risk factors, early disease screening, diagnosis, staging, treatment, shared care (between referring physicians and cancer specialist), follow-up monitoring, and advanced disease management--are applied to the management by family physicians of the spectrum of cancer. Family practice training programs emphasize competencies necessary to identify serious disease in the undifferentiated patient, continuity of care, comprehensive care, human behavior, preventive medicine, community medicine, and integration and management skills. Consequently, family physicians maintain overall patient management. The competencies acquired in family practice residency training prepare graduates for roles in the management of every stage of the natural history of a chronic disease such as cancer. The author describes the roles that family physicians are prepared to assume in the management of cancer patients at the eight stages of disease management: 1) monitoring risk factors--establish cancer risks for every patient and provide appropriate periodic review of each risk; 2) early disease screening--utilize the screening recommendations of the American Cancer Society and develop an office procedure to maintain the continuity of this effort; 3) diagnosis--follow up on positive screening results and pursue causes of presenting symptoms; 4) staging--use the results of staging procedures to guide patient choice of alternative treatments; 5) treatment--although some family physicians choose to administer chemotherapy under the direction of cancer specialists, all will find themselves involved in counseling patients and their families, in providing family support, and in arranging for utilization of community resources; 6) shared care (comanagement)--share the monitoring of treatment progress and side-effects; this entails support of the patient and family throughout all stages of the disease; 7) follow-up monitoring--continued follow-up of patients once they are considered "cured" (e.g., monitor for recurrence or second primary disease); and 8) advanced disease management--manage symptoms, pain, and quality of life when cure is no longer an option.